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Tuesday, September 30, 2014

It’s September 30, 2014

Today is the deadline for CSHM to have divested in all of the Small Smiles clinics.  Have they? Have the simply rebranded?

I don’t know.

Monday, September 29, 2014

DD Marketing, Small Smiles Dental Centers: Double dipping?

In 2003 while dental centers owned by the DeRose family were coming under fire for abusive dental treatment of children, by North Carolina investigative reporter, Stuart Watson, South Carolina was gearing up to  not only allow the clinics to operate in the state, but also let the taxpayers foot the bill for the clinics advertising while it lured children to the torture chambers. School districts signed contracts with DD Marketing agreeing to pay them $48K per year plus 20% commission, and DD Marketing would work their hardest to recruit advertisers to assist in generating income for the schools.  By August 2003 the South Carolina school district was locked in a lengthy and complicated contract with DD Marketing.

First recruited advertiser, was Children’s Medicaid Dental Clinics—Small Smiles Dental Centers as we know it—who contracted to pay the school district $10K so they could hang 2 x 5 foot banners in schools and adorn school vehicles with signage.  In return the school district paid DD Marketing $6K for that first advertiser—$4K monthly fee plus $2K commission.


Problem? DD Marketing and Children’s Medicaid Dental Centers, were owned by the same people. Stink? Yes! Multiply that by nearly 200 districts across the county and that’s nearly $1Mil in additional revenue and it stinks way past “high heaven”.

Small Smiles Ad Scam

Vending machines were also allowed in the schools of which DD Marketing also reaped a hefty profit; need those to keep the patient flow up at the clinics, right?
Double dipping? More like Quadruple dipping in my opinion.

Schools Welcome Ads, March 5, 2003

“Pueblo, Colorado-based DD Marketing will receive $4,000 a month to recruit business and 20 percent of the proceeds generated for the district.”
CHEROKEE COUNTY SCHOOL DISTRICT NO. 1 Minutes, March 11, 2003
“Mr. Paige Carlton - Tompkins, Kinard & Associates, an advertising and consulting service whose regional office is located in Columbia, South Carolina; Mr. Dan DeRose - President of DD Marketing, Inc.; and Mr. Mike Roumph - Vice President of DD Marketing, Inc. (DDM); made a marketing presentation to trustees. The company is located in Pueblo, Colorado and is a consulting service for marketing and advertising that works to meet the specific needs of government, public and private agencies, political organizations, corporations and individuals by developing a multi-faceted campaign to generate revenue for the client. The firm provides detailed research and analysis to develop partnerships for clients such as education, economic development, transportation, energy and natural resources, and environmental regulations.

Tuesday, September 16, 2014

Mechanisms of Dental Sealant Scams

By Michael W. Davis, DDS"Dr. Michael W. Davis maintains a private dental practice in Santa Fe, NM. One day per week, he assists at a dental clinic focused on disadvantaged children and adults. Dr. Davis chairs the Santa Fe District Dental Society Peer-Review Committee. He is also an active member, in the New Mexico Dental Association House of Delegates, which drafts legislation relating to public protections in dentistry. Dr. Davis also serves as an expert witness, in dental legal cases. He may be reached at: MWDavisDDS@comcast.net

Mechanisms of Dental Sealant Scams
By: Michael W. Davis, DDS
September 16, 2014


Dental sealant scams have been a mainstay hustle, in unethical dental practices for numbers of years. The insurance industry terms this dishonest and unlawful activity, “upcoding”. It’s a highly lucrative and successful play, especially in Medicaid settings, because it costs nothing from the patient, and there’s no pain or discomfort generated. Here’s how it works.

The crooked doctor etches the tooth’s enamel surface with an acid gel, which has no dental caries (dental cavity). The tooth may or may not have a stain, which certainly doesn’t require clinical restoration (filling). Next, they place a flowable resin-composite into the tooth’s pits & grooves. This is a tooth-colored material, which lacks physical properties of strength and wear resistance. Manufactures never recommend flowable resin-composites to be used in high physical stress areas, like the chewing surfaces of teeth. Basically, the clinician has delivered the service of a dental sealant.

However, unlike a preventive service like a sealant, this “service” is billed out as a resin-composite restoration. Not only does this activity generate more billable fees, but also each surface the flowable resin-composite contacts generates additional billable fees. While a preventive dental sealant may command in the neighborhood of a $35-40 fee, a multiple surface resin-composite restoration will produce a fee ranging from $85-170. The only real limitation is the greed of the dishonest dentist.

Sometimes, the doctor may actually roughen the enamel surface, for better adhesion of the restoration (in reality, a sealant). However, because of the compromised material used, a general lack of adjusting of the patient’s occlusion (the manner in which teeth bite together), and the rush to maximize production under a challenging Medicaid fee schedule, this form of restoration has a compromised longevity. The compromised longevity is yet another moneymaker, in that these “fillings” require frequent replacement.

When I’ve audited Medicaid patient records, it’s rare to actually see any radiographic evidence of tooth decay on teeth restored like this. (On review of x-rays, there’s no indication of any prior tooth decay.)  Further, once these teeth are restored, there’s still no evidence of these restorations entering dentin (Dentin is the tooth structure under enamel, which is a qualifier for a definitive dental restoration, under most Medicaid and insurance programs).

One exception is “preventive resin restorations” (PRRs), which are not a covered service under most insurance and Medicaid plans. Under magnification, and using micro-air abrasion or a fissurotomy bur, the doctor selectively removes only the caries-affected enamel. PRRs do not command an equal fee for restorations, which enter into dentin. However, that won’t stop an unethical dentist for charging, for the more lucrative service.

A sealant scam is difficult to pull off, with private pay and dental insurance patients. Here are the reasons why.

Whether the patient (or their parents) pays the full amount, or simply a lesser-required co-payment, they have “skin in the game”. They feel a pinch in their pocketbook. If these “fillings” fail to hold up, which is virtually guaranteed, patients will complain. They may complain to the doctor, the state dental board, professional peer-review, a civil attorney, their insurance company, or their employer who purchases the dental plan. They are also highly likely to discontinue services with an unethical doctor, who provides this disservice.

By contrast, Medicaid patients have no skin-in-the-game. They pay nothing. They absolutely rejoice, when a dentist places a large “filling”, which doesn’t require Novocain (local anesthetic), and never hurts. They have no concern; this “restoration” is replaced or repaired every 2-3 years. This creates an ever-renewing financial annuity, for a crooked doctor. 

Further aiding the dishonest doctor is the abysmal to nonexistent oversight provided by Medicaid regulators. While dental insurance auditors are very well aware of this common dental scam, Medicaid auditors are generally clueless. I seriously don’t know if Medicaid auditors are mostly corrupt, lazy, or stupid. Regardless, I don’t have the time or energy, to broker fools.

So far, I’ve focused on the role played by dishonest dentists. Numbers of corporate dental clinics also play this fraudulent game on Medicaid. These dental service organizations (DSOs), which purport to limit their supervision to non-dental activities, misrepresent the reality. They are active in instructing doctors, on how to cheat the system. The private equity investors, clinic managers, and fraudster doctors all dip their collective beaks, in taxpayer largesse. This represents corporate fraud on a massive interstate level. Unfortunately, since the victims are disadvantaged Medicaid beneficiaries and US taxpayers, regulators generally sit on their hands, or hide under their desks.

In conclusion, misrepresentation of dental sealants as resin-composite fillings is not a “billing error”, as some dental crooks would have you believe. These “fillings” are often placed upon specific teeth, and surfaces of teeth, not covered under a Medicaid program for sealants. These are intentional misrepresentations to deceive the Medicaid program, for one’s financial gain at taxpayer expense. This represents violations to the Unfair Trade Acts and False Claims Acts (both state and federal), which is fraud. Fraud is not malpractice, and a doctor’s malpractice insurance generally doesn’t cover for acts of fraud. Acts of fraud often carry both civil and criminal penalties. Financial penalties are generally treble (3X) damages.

We already have state and federal legislatures, which have enacted powerful laws onto the books. The problems primarily lie with worthless regulators. They are unwilling to enforce existing laws, to protect the disadvantaged and taxpayers. Government regulators too often serve as enablers, for white-collar criminal activity.

From my perspective, I hold Medicaid auditors and regulators to equal culpability, as the actual violators. By ignoring their lawful responsibility to enforce the rule of law, regulators give criminals a tacit green light. Sadly, this green light perpetuating dental Medicaid fraud has been frozen on “go”, for many years.

Monday, September 15, 2014

Small Smiles Dental Centers: Countdown to Exclusion is Business as Usual

As the days count down to CSHM Exclusion from Medicaid becomes effective on September 30, 2014 I’m getting more and more reports that “lead” dentists of the individual Small Smiles clinics are “purchasing” their respective clinics. (Colorado clinics, New Mexico clinics and Indiana clinics just to name a few that have been reported.)

Since January 2010 the clinics have been visited by monitors and care continued decline to the point they were Excluded from Medicaid participation as of September 30.  Several reports from monitors found care unacceptable as dentists and staff continued to deliver substandard care as reported in the bipartisan Senate Report.

How can leaving same dentists in place improve the situation?

It is more than highly likely dentists who have been delivering the unacceptable care and treatment for years will continue with business as usual and children are still at great risk and taxpayers will continue to be fleeced.

The risk may be greater than ever.

Anyone think care will be better?

The dentists and clinic operations may not have the watchful eye of the government monitors or be bound by any Corporate Integrity Agreement with HHS-OIG.  That Agreement was made with CSHM, the management company of the Small Smiles dental centers. (another pitfall of corporate owned dentistry)

Monday, September 08, 2014

Pediatric Dental Care for General Public verses Dental Care for the Underserved

Dentists, lawmakers and regulators should be ashamed for condoning, supporting and fostering such disparity in dental care for children in America.  They should all be ashamed and disgusted! I certainly am!

General Public Dental Care for children v care for underserved

Saturday, September 06, 2014

Small Smiles in Colorado Springs, Colorado is now Front Range Smiles, PLLC–Dr. Nathaniel Conrad Cejka

The can move down the street, they can change their name to Front Range Smiles, but as long as the same employees and same lead dentist work there it’s a Small Smiles; “by any other name as they say.”

The CSHM statement in March 2014 after it was announced Small Smiles Dental Centers were Excluded from Medicaid was correct; it has no effect on the clinics whatsoever. Business as usual and now, NO oversight!

I see little difference now than when Jodi Kuhn “purchased” the clinic for $100 from previous fake owner dentist, Randall Ellis in 2013. Only difference I see is they took the time to create a new business entity and slap another dentist’s name on the documents and moved down the road. BTW, this move to the new address was in the works BEFORE the Exclusion letter was announced.  Someone should get a look see at the lease.

(Hasn’t Kuhn purchased two or three of the clinics again? Wonder what new and improved name she is using these days and how much she paid for them when she bought them from herself?)

Frankly I smell a bunch of hoodlums from Pueblo involved. Am I alone?  It’s no secret I’ve believed for a very long time the Pueblo bunch very much still has their hand in the operations of the dental clinics in Colorado. There is more evidence supporting that hypothesis than disproving it, that’s for certain.

 

Front Range Smiles, PLLC f/n/a Small Smiles

 

Don’t believe Dr. Nathaniel Conrad Cejka is a Small Smiles Dentist? He is listed as a provider at each of their Colorado clinics in Delta Dental provider book dated April 2014. (You will find other “owner dentist” Jodi Kuhn listed right along with him).

Small Smiles - Dr. Nathaniel Cejka    Small Smiles – Dr. Jodi Kuhn
1404 Cejka-delta dental-aurora 1404 delta dental-jodi kuhn-aurora
1404 Cejka-delta dental-smile high 1404 delta dental-jodi kuhn-smile high
1404 Cejka-delta dental-springs 1404 delta dental-jodi kuhn-colorado springs
1404 Cejka-delta dental-thornton 1404 delta dental-jodi kuhn-thornton
   

Friday, September 05, 2014

Why are these children treated so differently?

None of these children had dental insurance. A and B had Medicaid, C paid out of pocket.
Ask yourself why the children in pictures A and B are treated differently than the children treated in picture C?
Years of studying this issue has revealed only one reason: Profits over Patients!
A.
Corporate Owned Dental Clinic For Children[2]
B.
Corporate Owned Dental Clinic For Children[1]
C.
Non-Corporate Owned Dental Clinic for Children

Wednesday, September 03, 2014

I've had it with agencies and investigators who say that are going to take it to crooked dentists!

After 8 years of blogging and more than a few new stress related grey hairs, I have had it.  I've had it with dentists who hurt kids.  I've had it with politicians and regulators that say they are going to stop children from being hurt.  I've had it with agencies and investigators who say that are going to take it to crooked dentists.  I've had it with a government that doesn't want to protect children.  In the last few months 3!! investigators have told me that after years of hunting, gathering evidence and being sickened at what they found, they have hit brick walls WITHIN their own agency.  Two quit, one after telling me about recent DEATHS in their state that were swept under the rug.

So here is my question for all of you readers - when are you going to wake up and say you've had it, too?  Do you not realize that the mouth and bank account of you and every person you love, is at risk?  This crap started almost a decade ago.  Did you really think that a decade of DeRose trained dentists would simply put in their time and then go into humble private practice without retaining any of their bad habits?

Don't be foolish.

Just like a fart stinks up a whole room, the fraudster dental clinic alumni started a stink that goes DEEP into the dental biz.  Think I'm wrong?  Tell me if this sounds familiar?

Case in point number one:
 
Your friend has a 14 year old boy who has had braces on for 3 years.  The new pediatric dentist who recently bought the practice where this boy is seen announces right before his braces are removed that he has developed 5 new cavities.  Because his brushing was probably not so good with those braces.  And his orthodontist isn't really looking for decay so didn't mention it.  These aren't your run of the mill pit and fissure cavities - these are the multiple surface (expensive) kind.  Might as well get them fixed and give that kid a lecture about how his lousy toothbrushing just cost you $1700 ON TOP of the braces, which weren't cheap!

So the dentist "fills" 5 teeth with itty bitty wholly enamel contained occlusal surface only goop and sends the bill to the parents.  Oh, I forgot to mention that the parents are both corporate lawyers.  With no dental insurance.  But nice cars and kids in private school so odds are that bill is going to be paid.

If you think Medicaid has no oversight, guess how much you get when you pay cash?  ZERO.  That 14 year old boy is a real kid - his parents paid $1700 for Dentally (Medically) Unnecessary care.  But how the heck are they going to know that?  Right now they think their son is a lousy brusher who will probably need a few more cavities fixed in the near future.  They may be corporate lawyers but their son is a sitting duck.

Do you really think that none of the DeRose trained dentists who have since moved on to private practice would not sense an opportunity if presented with such a scenario?  Or the ones who did some time at Kool Smiles?  Or maybe All Smiles?  Perhaps Comfort Dental?  Or maybe Aspen dental?

Case in point number two:
 
Last week the state of Texas startled citizens when it settled a $16 million dollar fraud case for less than the cost of a kitchen remodel!

Last week (August 28, 2014) the Texas Health and Human Services Office of Inspector General (THHS-OIG) setting a $16 million dollar dental fraud case against one of their top stainless steel crown fraudsters for $39,000! That’s right! Just about one quarter of one percent!
Someone please tell me how that is possible!!

In an article by “The Austin American-Statesman” it says:
“The deal represents the latest underwhelming outcome for state regulators who say they have identified hundreds of millions of dollars in dental and orthodontic fraud between 2007-2012, yet have struggled to produce decisive legal victories.”
Rachel Trueblood says the reason for the lowball number is, “There was a complete lack of evidence.”

Tuesday, September 02, 2014

CSHM still up and running, business as usual

Linda Zoeller at CSHM in Nashville still has a job and still filing questionable legal documents for Small Smiles, now known as (file in the blank) Youth Dentistry.

This was filed just today in Colorado.

140902 Springs Smiles Youth Dentistry, PC